| Organization Name: | PROGRESSIVE THERAPY ASSOCIATES |
| NPI Number: | 1699075945 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JODI LYNN HEDSTROM (SPEECH-LANGUAGE PATHOLOGIST) |
| Mailing Address: | 1150 Prairie Pkwy Suite 105 West Fargo |
| State: | ND US |
| Postal Code: | 580783168 |
| Phone Number: | 7013567766 |
| Fax Number: | 7013567765 |
| NPI Enumeration Date: | 11/02/2010 |
| NPI Last Update Date: | 01/25/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 840 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | ND |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |